Student Nomination Form

Student Nomination Form

The Peer Ambassador Program empowers students to support one another, promote mental wellness, and connect classmates to trusted adults when they need help. Ambassadors will receive training from Behavioral Health and Prevention staff in listening skills, boundaries, and connecting peers to support. You can nominate yourself or another student who you believe would be a great fit for this program.
Your Full Name*

First NameLast Name
Your Role

Student/FriendTeacher/StaffCounselorOther
Nominee Information
Student you are Nominating:*
First and Last Name
Grade Level of Nominee*
Nominee's Advisor (If known)
This student...

is a great listeneris respectful and trustworthyis kind and supportive to othersStays calm in stressful situationsLeads by exampleis dependable and responsibleMakes others feel included
What qualities does this person have that would make them a good peer ambassador?*
3 words to describe the person you are nominating:
Should be Empty:

Nominee Information